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The Inconvenience of Medical Insurance

The topic of health insurance generates a lot of heated emotion. That makes it a good campaign issue. A month ago, the Census Bureau reported that there are approximately 45 million people without health insurance in the United States. It turns out that only 8.2 million of those are truly hard cases, the rest either able to afford it or not without it for very long.

I know one of those hard cases, and I'd like to share some first-hand knowledge. Of course it's anecdotal and therefore you shouldn't generalize, but I do think it holds some explanatory power. (And I can get away with this because I don't think she reads my blog…)

With apologies to Homer Simpson, let's call her Jane D'oh. No, that's really mean and I didn't just write that. I don't have to use every pun I think of. Let's just call her J.

J fits the stereotype — a young single mother working several low-wage jobs and unable to make ends meet. She has no health insurance, among other things, although inexplicably she has a cell phone. She has a few relatively minor health problems she can't afford to get treated, but treatment would substantially improve her quailty of life. Sorry, I'm not going to go into much detail.

Last year, I blogged my shocked reaction to news that more than one-third of people in the Oregon Health Plan were dropped for failing to make premium payments as low as $6 a month. (The premium schedule is available online.) Those are the kind of people who will only have health insurance if they're not inconvenienced by any responsibility for it at all.

I don't know if J was among the dropped; she may never have been in the program, or even eligible for it. But recent experience makes me believe she's the kind of person to whom a $20 monthly premium would be a significant obstacle. And that it's a bigger psychological hurdle than financial.

A few months ago I was in possession of a coupon for a very cheap initial visit with a chiropractor. I thought it could help with J's headaches, and gave her the coupon and some extra money that would make it completely free to her. (I had also told the chiropractor I would pay for a few followup visits, which J never knew.) All she had to do was schedule the appointment. She never did, even after my reminding her and her being apologetic for forgetting.

She turned down free health care for a problem that had been bothering her for a long time.

Now J has a small piece of glass in her foot and doesn't want to see a doctor to have it removed. It's not indifference, she positively does not want to see one. I think she tragically undervalues her own health and don't see a way to get her to the doctor short of kidnapping. Which I shouldn't even be thinking about, for the temptation of doing it. It's hard for me to resist a crazy plan!

I'm feeling dramatic. It should go something like this:

How may I help you?
J has a piece of glass in her foot. We need to see a podiatrist right away.
Do you have a referral? Who is the insurance?
I'm her referral, and her insurance. <place a small stack of $50s on the desk.>
Yes, sir! I'll page a doctor immediately.
Oh, my hero! <swoon>

Urm, except for that last part, it sounds pretty good, right?

I suspect J's refusal to seek health care is a self-esteem problem. She doesn't value herself, so she doesn't value her health. She complains about it but resists action to impove it — even when encouraged, and when it's free.

This is the kind of article well-suited to an ending of "I don't know what to do." But I do. I need to talk to her for a few minutes to learn the specific reasons she doesn't take care of herself.

And if that fails, try the kidnapping.

Tiny Island